Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients

Abstract Purpose Orotracheal intubation is known to impair cough reflex, but the validity of cough reflex testing (CRT) as a screening tool for silent aspiration in this population is unknown. Material and methods One hundred and six participants in a tertiary-level intensive care unit (ICU) underwe...

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Bibliographic Details
Published in:Journal of critical care 2016-06, Vol.33, p.90-94
Main Authors: Kallesen, Molly, Psirides, Alex, Huckabee, Maggie-Lee
Format: Article
Language:English
Subjects:
Acids
Aged
Airway Extubation - adverse effects
Aspiration
Bronchoscopy
Citric Acid - administration & dosage
Cough
Cough reflex
Critical Care
Data analysis
Dysphagia
Endoscopy
Extubation
Female
Humans
ICU
Intensive care
Intensive Care Units
Intubation
Intubation, Intratracheal - adverse effects
Male
Middle Aged
Nebulizers and Vaporizers
New Zealand - epidemiology
Palliative care
Prevalence
Reflex - physiology
Researchers
Respiratory Aspiration - diagnosis
Respiratory Aspiration - epidemiology
Respiratory Aspiration - etiology
Respiratory Aspiration - prevention & control
Sensitivity and Specificity
Studies
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Summary:Abstract Purpose Orotracheal intubation is known to impair cough reflex, but the validity of cough reflex testing (CRT) as a screening tool for silent aspiration in this population is unknown. Material and methods One hundred and six participants in a tertiary-level intensive care unit (ICU) underwent CRT and videoendoscopic evaluation of swallowing (VES) within 24 hours of extubation. Cough reflex threshold was established for each participant using nebulized citric acid. Results Thirty-nine (37%) participants had an absent cough to CRT. Thirteen (12%) participants aspirated on VES, 9 (69%) without a cough response. Sensitivity of CRT to identify silent aspiration was excellent, but specificity was poor. There was a significant correlation between intubation duration and presence of aspiration on VES ( P = .0107). There was no significant correlation between silent aspiration on VES and length of intubation, age, sex, diagnosis at intensive care unit admission, indication for intubation, Acute Physiology and Chronic Health Evaluation III score, morphine equivalent dose, or time of testing postextubation. Conclusions Intensive care unit patients are at increased risk of aspiration in the 24 hours following extubation, and an impaired cough reflex is common. However, CRT overidentifies risk of silent aspiration in this population.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2016.02.004